1. Benzodiazepine discontinuation with prolonged-release melatonin: hints from a German longitudinal
Kunz D1, Bineau S, Maman K, Milea D, Toumi M. Expert Opin Pharmacother. 2012 Jan;13(1):9-16. doi:
10.1517/14656566.2012.638284. Epub 2011 Nov 22.
OBJECTIVE: Prolonged-release (PR) melatonin is approved in Europe for the treatment of insomnia in
patients aged 55 years and above. The objective of the study was to describe its prescription patterns and
its impact on hypnotics use in routine clinical practice.
RESEARCH DESIGN AND METHODS: This is a retrospective study analyzing PR melatonin prescription
data from a German longitudinal database (IMS(®) Disease Analyzer). All patients initiating PR melatonin
over the 10 months after approval (April 2008 - February 2009) were included. Patients were classified
according to their use of hypnotic benzodiazepines or benzodiazepine-like drugs (BZD/Z) in the 3-month
period before and after PR melatonin initiation.
RESULTS: Of the 512 eligible patients, 380 (74%) were aged ≥ 55 years, 344 (67%) women and 112 (22%)
previous BZD/Z users. Most of the latter (79/99, 79.8%) had used BZD/Z for at least 180 days.
Approximately one-third (35/112, 31%) discontinued BZD/Z after PR melatonin initiation, and the BZD/Z
discontinuation rate was higher in patients receiving two or three PR melatonin prescriptions than in
patients receiving only one prescription (10/24 = 42% vs 25/88 = 28%, p = 0.21). Of the 400 patients without
prior BZD/Z use, 39 (10%) received BZD/Z during the follow-up.
CONCLUSIONS: Based on the observed 31% discontinuation rate, PR melatonin may help to facilitate
BZD/Z discontinuation in older insomniacs.